title: Does providing care for uninsured patients decrease emergency room visits and hospitalizations?
abstract: BACKGROUND
  Access to primary care could reduce use of more costly health care by uninsured individuals through prevention and early treatment. We analyzed data from a program providing free primary care to test this hypothesis.
  
  
  METHODS
  We compared emergency room (ER) visits and hospitalizations among uninsured, low-income adults who received immediate versus delayed access to a program providing free primary care, including labs, X-rays, and specialty consultation. We used surveys to identify ER visits and hospitalizations during the 12 months preceding and following program enrollment or wait list entry.
  
  
  RESULTS
  Hospitalizations decreased from the year before entry to the year following entry in participants with immediate and delayed (6.0% vs 8.8% decrease) access. ER use also decreased in both groups (11.2% vs 15.4%).
  
  
  CONCLUSIONS
  Free primary care services and specialty consultation did not reduce use of more costly health care services during its first year. More prolonged availability of primary care might have greater impact.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Mackinney
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Visotcky
authors.forename: Sergey
authors.initials: S
authors.lastname: Tarima
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002908:Chronic Disease; D017046:Cost Savings / Q000379:methods; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D017146:Models, Organizational; D011203:Poverty; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D015397:Program Evaluation; D057216:Propensity Score; D017664:Uncompensated Care / Q000191:economics / Q000706:statistics & numerical data*; D014922:Wisconsin
keywords: community health; health outcomes; impact evaluation; primary care; program evaluation